Press Room

Says Medicare is missing the opportunity to protect program solvency. Washington, D.C. – Recently, while testifying before the House Budget Committee regarding the current scale of government improper payments, the U.S. Comptroller General Gene Dodaro reiterated recommendations that CMS should implement a permanent Recovery Audit Contractor Prepayment Review Program. The Comptroller General said: “We recommended that CMS seek legislative authority to allow RAs to conduct prepayment claim reviews. HHS did not concur with this recommendation, stating that CMS has implemented […]

The Office of Inspector General at HHS said Wednesday that an audit of 2012 and 2013 claims revealed that Mount Sinai Hospital did not fully comply with Medicare billing requirements. The agency audited 261 claims and found that 110 resulted in overpayments totaling at least $41.9 million for the audit period. Mount Sinai in New York City is required to do its own investigation of the problem going back six years, and refund the federal government all overpayments within 60 […]

Today, more than 55 million Americans rely on Medicare for health and financial security as they age. Unfortunately, current beneficiaries, along with those who expect to enroll in the future, are unaware that the healthcare program they have long counted on to support them as they age will look much different in just 10 years – and not for the better. Medicare Trustees report that at current high spending levels and with the expected influx of new beneficiaries, the program […]

Guest Columns Warnings about Medicare’s future continue to be ignored The Government Accountability Office has released its 2017 “High Risk List,” which identifies federal agencies and programs vulnerable to fraud, waste, abuse and mismanagement. The list is published every two years at the start of a new Congress, raising the alarm about areas that greatly need attention and redirection. First designated as “high risk” back in 1990, Medicare has made the GAO list every year since due to “its size, […]

Leveraging expertise of recovery auditors could prevent billions lost to improper billing Washington, D.C. – Today, the Council for Medicare Integrity (CMI) asked Members of Congress to champion the authorization of a prepayment Recovery Audit Contractor (RAC) Program to review Medicare Fee-For-Service (FFS) claims before they are paid to identify errors and prevent tens of billions in improper payments from draining from the program each year. Medicare loses more money to improper payments than any other program government-wide. An improper […]

A bill aimed at expediting the Medicare appeals process is expected to be reintroduced in the coming months, according to one healthcare insider. The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act, first introduced in late 2015, would add more resources to the Office of Medicare Hearing and Appeals to help combat the growing backlog of Medicare claim appeals. The original version of the bill pledged $125 million to OMHA, and $2 million to the Departmental Appeals Board […]

Advocacy Group Offers Suggestion for Texas and its Improper Medicare Payments Posted on March 16, 2017 DALLAS (WBAP/KLIF News) — An advocacy group says it has a way to help Texas fix its improper Medicare payment problem. Leslie Paige is with the organization Citizens Against Government Waste and says hiring private auditors can do even more than hold the state accountable for what the group considers a major problem. “These private auditors identify claims that have been improperly paid, and […]

Found: $40 billion for the federal budget Discussions about the federal budget take center stage this week, sparking conversations about where to cut and where to increase funding. One important issue to consider is how we might reduce waste and improper payments in order to infuse more resources into vital programs that are struggling financially. Medicare wastes more taxpayer dollars than any other program government-wide, with more than $40 billion lost annually. It’s outrageous that the federal government allows such […]

Report: TX Leads U.S. States In Medicare Waste A new report from a government watchdog group shows Texas is the biggest Medicare money waster among all of the States. “One of the big issues with Medicare is it wastes a tremendous amount of money” said Leslie Paige with Citizens Against Government Waste. California, New Jersey, Pennsylvania, and Florida rounded out the top five in the ranking of States based on how much money the group says is being wasted in […]

Reinstituting RAC Medicare Audits Would Add $40 Billion Per Year To The Federal Budget Guest commentary curated by Forbes Opinion. Avik Roy, Opinion Editor. Opinions expressed by Forbes Contributors are their own. GUEST POST WRITTEN BY Kristin Walter Ms. Walter is spokesperson for the Council for Medicare Integrity. As the Trump Administration and the 115th Congress dive into reform of the Affordable Care Act (ACA) and take steps to reduce the federal budget, discussions about improper payments within the Medicare […]